Article type
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Abstract
Background: Gout is the most common inflammatory arthritis and Colchicine is the primary choice, which was not yet in the 17th WHO Essential Medicines List and applied to be added. So we are appointed to perform a review of colchicine for gout by the WHO 19th Expert Committee on Selection and Use of Essential Medicines.
Objectives: To assess the efficacy, safety, cost of colchicine for gout, and provid evidence forWHO Expert Committee.
Methods: Databases of the Cochrane Library, PubMed, EMBASE, VIP, CNKI, Wanfang and reference lists of relevant reports were searched. Systematic reviews, meta-analysis, clinical guidelines and clinical studies of colchicine for gout were included. Study inclusion, quality assessment and data extraction were performed by two independent reviewers. We would conduct meta-analysis if possible, or a narrative summary instead.
Results: One meta-analysis (43 patients), Five RCTs (550 patients), and 118 case reports (118 patients) were included, and we conducted two meta-analysis to evaluate the efficacy and dose relevant of colchicine. Efficacy: the meta-analysis suggested that colchicine could reduce the pain or VAS score (MD:−34.00, 95% CI:−50.33,−17.67) for gout with higher events of diarrhea (MD: 49.85, 95%CI: 15.28, 162.60), comparing with the placebo. Low dose has equal efficacy with high dose (RR: 0.97, 95% CI: 0.75, 1.25), but lower events of diarrhea (RR: 4.03, 95% CI: 2.81, 5.77). Safety: The major adverse event is diarrhea, especially higher in high dose group. Other AEs are neuromyopathy, leucopoenia, liver dysfunction. SAEs such as rhabdomyolysis, multi-system organ failure also reported in some case reports. Cost: The public price of colchicines is 0.2USD/1mg in China, comparing the average cost of 0.11–0.13USD/1mg in most countries except the USA.
Conclusions: Based on current clinical evidence, colchicine was effective for gout, ADRs are dose relevant, the cost was acceptable. Low dose could be the priority choice. So, we recommended colchicine be added to 17th WHO EML.
Objectives: To assess the efficacy, safety, cost of colchicine for gout, and provid evidence forWHO Expert Committee.
Methods: Databases of the Cochrane Library, PubMed, EMBASE, VIP, CNKI, Wanfang and reference lists of relevant reports were searched. Systematic reviews, meta-analysis, clinical guidelines and clinical studies of colchicine for gout were included. Study inclusion, quality assessment and data extraction were performed by two independent reviewers. We would conduct meta-analysis if possible, or a narrative summary instead.
Results: One meta-analysis (43 patients), Five RCTs (550 patients), and 118 case reports (118 patients) were included, and we conducted two meta-analysis to evaluate the efficacy and dose relevant of colchicine. Efficacy: the meta-analysis suggested that colchicine could reduce the pain or VAS score (MD:−34.00, 95% CI:−50.33,−17.67) for gout with higher events of diarrhea (MD: 49.85, 95%CI: 15.28, 162.60), comparing with the placebo. Low dose has equal efficacy with high dose (RR: 0.97, 95% CI: 0.75, 1.25), but lower events of diarrhea (RR: 4.03, 95% CI: 2.81, 5.77). Safety: The major adverse event is diarrhea, especially higher in high dose group. Other AEs are neuromyopathy, leucopoenia, liver dysfunction. SAEs such as rhabdomyolysis, multi-system organ failure also reported in some case reports. Cost: The public price of colchicines is 0.2USD/1mg in China, comparing the average cost of 0.11–0.13USD/1mg in most countries except the USA.
Conclusions: Based on current clinical evidence, colchicine was effective for gout, ADRs are dose relevant, the cost was acceptable. Low dose could be the priority choice. So, we recommended colchicine be added to 17th WHO EML.
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